OCP users were defined as having used OCPs for at least 12 months and were divided into four categories by type of pill use: high estrogen and progestin
; high estrogen/low progestin
; low estrogen and progestin
; and low estrogen/high progestin
as we await further evidence on safety and efficacy of estrogen alone, different routes of administration, lower doses, and probably sequential rather than continuous progestin
Two types of intrauterine devices (IUDs) also provide long-acting, reversible contraception in part by releasing progestin
directly into the uterine lining.
The US Food and Drug Administration recently approved Natazia (Bayer HealthCare), a novel four-phase, estrogen step-down, progestin
step-up regimen that contains a new estrogen, estradiol valerate, and the novel progestin
The revised label states that women who choose to rake estrogens or an estrogen and progestin
combination after talking to their physician should have annual breast exams and periodic mammograms based on their age and risk factors.
Using estrogen and continuous progestins
, however, appeared to have little association with increased risk of epithelial ovarian cancer: Women who had used estrogen and continuous progestins
showed a 1.02 risk ratio, compared with those who had never used the combination.
Grapefruit juice increases the enzymatic activity of CYP3A4, thus increasing degradation and reducing the concentrations and effectiveness of progestins
and ethinyl estradiol.
Maintaining menstrual cycles, a function of progestins
, is important during childbearing years because the shedding of the uterine lining each month reduces the risk of endometrial cancer.
In the meantime, less-frequent administration of progestins
is worth exploring.
The addition of estrogen by means of a combination oral contraceptive appears to be a good solution for some types of dysfunctional bleeding not related to the progestin
IUD, but it may be a poor suggestion in this scenario.
Natural progesterone creams are available over-the-counter (OTC), but be aware that they are not as strong as synthetic progestins
or micronized progesterone and should not be used as a substitute for the progestogens contained in combination estrogen products.
Whereas use of the older HRT regimens, which contain progestins
with more androgenicity, resulted in a decrease in total cholesterol, a decrease in the so-called cardioprotective high-density lipoprotein cholesterol (HDL) was also seen.